| Course | NUR 659 Healthcare Safety, Just Culture, and Regulation |
|---|---|
| Module | Module 5 |
| Paper type | milestone paper selecting and implementing proven safety interventions |
| Length | About 1,070 words, 6 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 659 Module 5
Milestone Two: Implementing a Central Line Bundle and a Surgical Safety Checklist So They Actually Work
[Student Name]
Southern New Hampshire University
NUR 659: Healthcare Safety, Just Culture, and Regulation
Module Five Milestone Two
[Instructor Name]
[Date]
Milestone Two: Implementing a Central Line Bundle and a Surgical Safety Checklist So They Actually Work
Few patient safety interventions have stronger evidence than the central line bundle and the surgical safety checklist. Both are inexpensive and simple, and both have been followed by large reductions in harm. Yet many hospitals that adopt them see little change, because staff complete forms without changing practice. Westbrook, a composite 220-bed community hospital, illustrates the problem. Central line-associated bloodstream infections in its twelve-bed ICU have risen to three per 1,000 catheter days, above the national benchmark, and an audit of its operating rooms found that the surgical checklist was marked complete for 96% of cases but actually read aloud with the team present in only 31%. This milestone plans how to implement both interventions effectively. It argues that the success of these tools depended on how they were introduced, and that implementation must reproduce those conditions.
The Evidence for the Central Line Bundle
Pronovost et al. (2006) led a statewide program in 103 intensive care units in Michigan focused on five evidence-based practices to prevent catheter-related bloodstream infections: hand hygiene, full barrier precautions during catheter insertion, chlorhexidine skin preparation, avoiding the femoral site and removing unnecessary catheters. The program also included a checklist during insertion, empowerment of nurses to stop the procedure if steps were skipped, a cart with all necessary supplies and regular feedback of infection rates to each unit. The median infection rate fell to zero within three months, and the mean rate declined substantially over eighteen months of follow-up. The results were sustained in later reports and prompted similar programs nationally.
The Evidence for the Surgical Checklist
Haynes et al. (2009) introduced the World Health Organization surgical safety checklist in eight hospitals in eight cities, ranging from high-income to low-income settings. The checklist includes items at three points, before anesthesia, before the first cut and again before the patient is wheeled out, such as confirming the patient's identity and procedure, team introductions, anticipated critical events and counts of instruments and sponges. After implementation, the death rate fell from 1.5% to 0.8% while in-hospital complications dropped from 11.0% to 7.0% of patients. With no concurrent control group, other changes may have contributed, but the size and consistency of the improvement across diverse settings drew wide attention.
Why Michigan Worked
Dixon-Woods et al. (2011) studied the Michigan program in depth to explain its success. They concluded that the checklist itself was only part of the story. The program built a networked community of ICU teams who shared experiences, used a compelling narrative about preventable deaths to motivate change, gave nurses permission to challenge physicians who skipped steps, fed back data in a way that created healthy peer pressure and supported local teams with coaching. They warned that other programs that copied the checklist without these social and cultural elements often failed to reproduce the results. The lesson for Westbrook is that the paper tools are necessary but not sufficient.
Implementation Plan for the ICU
Westbrook will implement the bundle with the elements Michigan combined. A central line cart stocked with everything needed for insertion will be placed in each ICU pod so that the easy path is the safe path. During every insertion, the nurse will use a short checklist and is explicitly empowered, with written support from the chief medical officer, to stop the procedure if a step is missed; physicians were briefed in advance and the ICU medical director modeled accepting such challenges. Daily rounds will include the question whether each line is still needed. Infection rates will be posted on the unit monthly, and each infection will be reviewed by the unit team within a week. Westbrook will join a regional hospital collaborative so that its ICU team can learn from peers facing the same work.
Implementation Plan for the Operating Rooms
The checklist audit showed that the problem was not the form but how it was used. Surgeons and anesthesiologists reported that the checklist felt like paperwork, and nurses felt uncomfortable insisting on it. The plan begins with the surgeons: the chief of surgery and two respected surgeons will lead the relaunch, explaining the evidence and modeling the full time-out. The checklist will be adapted by an operating room team to Westbrook's procedures, keeping the core items but removing items that duplicate other processes, since ownership improves use. The circulating nurse will lead the checklist aloud, and no incision will begin until it is complete. Observers will audit a random sample of cases each month for actual performance, not documentation, and results will be shared with each surgical service.
Measures and Expected Results
For the ICU, the outcome measure is line-related bloodstream infections for every thousand days a catheter is in place, with process measures of checklist completion during insertion and catheter days per patient day. For the operating rooms, the process measure is the proportion of observed cases in which the checklist is read aloud with the full team present, with surgical site infections, unplanned returns to the operating room and wrong-site events as outcome measures. The targets are an ICU infection rate below one per 1,000 catheter days within a year and observed checklist performance above 90% within six months.
Anticipating Resistance
Both relaunches will meet resistance, and planning for it is part of implementation. Some ICU physicians may see a nurse's authority to stop an insertion as a challenge to their judgment; the ICU medical director will discuss the policy with each physician individually before launch and will personally back nurses who use it. Some surgeons may view the full time-out as a delay; data from the first month of audits, showing how long the checklist actually takes, usually under two minutes, will be shared with them. Nurses may fear retaliation for speaking up, so the chief nursing officer will make clear that any retaliation will be treated as a serious professional matter. Early problems will be reviewed openly at monthly meetings, and the checklist will be revised if items prove unworkable, so that staff see their feedback shaping the tools.
Conclusion
The central line bundle and surgical checklist are among the best-supported safety interventions, but their success depended on how they were introduced. Reproducing the social elements identified in the Michigan program, empowerment, leadership, data feedback and peer learning, alongside the tools themselves, gives Westbrook a chance to achieve results rather than completed forms.
References
Dixon-Woods, M., Bosk, C. L., Aveling, E. L., Goeschel, C. A., & Pronovost, P. J. (2011). Explaining Michigan: Developing an ex post theory of a quality improvement program. The Milbank Quarterly, 89(2), 167-205. https://doi.org/10.1111/j.1468-0009.2011.00625.x
Haynes, A. B., Weiser, T. G., Berry, W. R., Lipsitz, S. R., Breizat, A. H. S., Dellinger, E. P., Herbosa, T., Joseph, S., Kibatala, P. L., Lapitan, M. C. M., Merry, A. F., Moorthy, K., Reznick, R. K., Taylor, B., & Gawande, A. A. (2009). A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine, 360(5), 491-499. https://doi.org/10.1056/NEJMsa0810119
Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., Cosgrove, S., Sexton, B., Hyzy, R., Welsh, R., Roth, G., Bander, J., Kepros, J., & Goeschel, C. (2006). An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine, 355(26), 2725-2732. https://doi.org/10.1056/NEJMoa061115
What the NUR 659 Module 5 instructions ask for
Milestone Two in NUR 659 usually asks you to select evidence-based interventions for a safety problem you analyzed and to plan their implementation. Expect to review the evidence, explain why the interventions fit the problem and describe implementation steps, roles and measures. Plan on five to seven pages in APA 7. Describe each intervention's full set of components, including the supporting elements beyond the checklist, report study designs and results accurately, draw on research about why interventions succeed or fail, include leadership, empowerment and data feedback in your plan and measure actual performance rather than documentation alone. Anticipate resistance from each professional group and plan how leaders will respond, including protection for nurses who speak up.
How this NUR 659 Module 5 milestone two example is built
This milestone plans a central line bundle and a surgical checklist relaunch at a composite hospital where ICU infections have risen and the checklist is marked complete but rarely performed. It summarizes the Pronovost Michigan program, the Haynes WHO checklist study with deaths falling from 1.5% to 0.8% and the Dixon-Woods explanation that Michigan's success came from networks, empowerment and data feedback. The ICU plan adds a supply cart, nurse authority to stop insertions and a regional collaborative, while the operating room plan uses surgeon champions and audits of actual performance. A section on resistance plans individual physician conversations, shares audit data on checklist time with surgeons and protects nurses from retaliation.
Where the NUR 659 Module 5 rubric puts the points
Grading of intervention milestones commonly weighs the fit between interventions and the problem, accurate use of evidence, attention to implementation science, the specificity of roles and steps, measurement and APA 7 writing. Top-band papers describe the complete intervention, not just the checklist, and acknowledge limitations of study designs such as before-and-after comparisons. Graders reward implementation plans that reproduce the social mechanisms behind success, including leadership modeling and staff empowerment, and that audit real performance. Setting realistic targets and measuring both process and outcome shows a complete plan. Anticipating resistance from specific groups, and planning concrete responses, often separates top papers from adequate ones, as does willingness to revise tools based on staff feedback.
NUR 659 Module 5 help: the mistakes that cost points
Intervention papers lose points when a checklist is presented as the whole intervention, when evidence is overstated, when implementation relies on education and a memo or when compliance is measured by documentation rather than observation. Another gap is ignoring physician engagement. Describe all components, report evidence honestly, use research on why programs succeed, build in leadership, empowerment and feedback and audit real performance. If your problem involves falls, pressure injuries or catheter-associated urinary infections, send it with your NUR 659 prompt so the interventions fit. Plan for resistance from physicians and surgeons, protect nurses who speak up and be willing to revise the tools when staff show that an item does not work in your setting.
Get NUR 659 Module 5 written to your instructions
Describe the safety problem in your NUR 659 milestone and attach the rubric. Your paper will choose proven interventions, describe every component, plan implementation that reproduces what made them work and measure real performance, within 24 to 48 hours, free the first time. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
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NUR 659 Module 5 questions, answered
Where can I find a free NUR 659 Module 5 Milestone Two sample?
This page carries the full paper: a central line bundle and surgical safety checklist, the Michigan and WHO evidence and an implementation plan that goes beyond the forms.
What are the elements of the central line bundle?
Hand hygiene, full barrier precautions, chlorhexidine skin preparation, avoiding the femoral site and removing unnecessary catheters.
Did the WHO surgical checklist reduce deaths?
In an eight-hospital study, deaths fell from 1.5% to 0.8% and complications from 11.0% to 7.0% after implementation.
Why did the Michigan ICU program succeed?
Researchers credited a networked community, a compelling narrative, nurse empowerment, data feedback and coaching, not the checklist alone.
How should checklist compliance be measured?
By observing whether the checklist is actually performed with the team, since documentation often overstates real use.